LATENT CLASS ANALYSIS OF DEMAND FOR MEDICAL CARE SERVICE

本文提出的研究目标是开发和评估 需求实证分析的替代计量经济学模型 用于医疗保健服务。 我们建议仔细比较， 评估一种新的建模方法，基于潜在类（或 有限混合）模型（LCM），目前领先的范例， 分析医疗保健服务的使用，两部分模型，（TPM）。 的 TPM框架是由兰德公司提出并实施的 在兰德健康保险实验（RHIE）的背景下。 的 研究目标将使用来自 RHIE，使用医疗保健支出和计数数据衡量 利用率 本研究的中心焦点将是一个比较 分析其他计量经济学方法和建立模型 的响应能力的实质性影响 医疗服务利用对价格、收入和健康的影响 状态变量LCM框架更灵活，但它也 在概念上和计算上要求更高。 最近的进展 多年来，重新评估中央和有影响力的 兰德研究的见解。 虽然RHIE数据现在已经过时， 然而，它们仍然适合于目标，因为它们是 在一个实验设计中，家庭被分配 外生保险计划。 有一个科学的价值， 使用更新的模型对RHIE卫生利用数据进行新的分析 工具，以及期望所提出的方法产生新的 洞察力，并改进完善的两部分建模 框架. 我们提出了模型选择标准和交叉验证方法 比较LCM和TPM框架，重点关注以下内容 问题：保险对不同国家医疗需求的影响 利用水平：将个人分为高利用和低利用， 低使用类别;平均医疗利用预测 针对特定患者类型和假设风险池的服务。

The objective of the research proposed here is to develop and evaluate alternative econometric models for the empirical analysis of the demand for medical care services. We propose a careful comparison and evaluation of a new modeling approach, based on the latent class (or finite mixture) model (LCM), with the currently leading paradigm for analyzing medical care services usage, the two-part model, (TPM). The TPM framework was proposed and empirically implemented by the RAND group within the context of the RAND Health Insurance Experiment (RHIE). The research objective will be implemented using the complete data from the RHIE, using both expenditure and count data measures of medical care utilization. The central focus in this research will be a comparative analysis of alternative econometric methodologies and model-building approaches, and the substantive implications for the responsiveness of medical care utilization to variations in price, income and health status variables. The LCM framework is more flexible but it is also conceptually and computationally more demanding. The advances of recent years make it feasible to reappraise the central and influential insights of the RAND study. Although the RHIE data are now old, they are nevertheless appropriate for the objective because they are generated within an experimental design in which household are assigned exogenously assigned insurance plans. There is scientific merit in a fresh analysis of the RHIE health utilization data using newer modeling tools, and reasons for expecting the proposed approach to yield new insights and to improve upon the well-established two-part modeling framework. We propose model selection criteria and cross-validation methodologies to compare the LCM and TPM frameworks with focus on the following issues: impact of insurance on demand for medical care at different levels of utilization: the classification of individuals into high- and low-use categories; prediction of average utilization of medical care services for specific patient types and hypothetical risk pools.